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Effect of moderate to high intensity aerobic exercise on blood pressure in young adults: The TEPHRA open, two-arm, parallel superiority randomized clinical trial

Williamson W 1 , Lewandowski AJ 1 , Huckstep OJ 1 , Lapidaire W 1 , Ooms A 2 , Tan C 1 Show all authors , Mohamed A 1 , Alsharqi M 1 , Bertagnolli M 1 , Woodward W 1 , Dockerill C 1 , McCourt A 1 , Kenworthy Y 1 , Burchert H 1 , Doherty A 3 , Newton J 4 , Hanssen H 5 , Cruickshank JK 6 , McManus R 7 , Holmes J 2 , Ji C 8 , Love S 9 , Frangou E 9 , Everett C 10 , Hillsdon M 11 , Dawes H 12 , Foster C 13 , Leeson P 1

Affiliations 

  • 1 Radcliffe Department of Medicine, Oxford Cardiovascular Clinical Research Facility Division of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
  • 2 Nuffield Department of Orthopaedics, Centre for Statistics in Medicine, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
  • 3 Nuffield Department of Population Health, BHF Centre of Research Excellence, University of Oxford, UK
  • 4 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
  • 5 Department of Sport, Exercise and Health, University of Basel, Switzerland
  • 6 School of Lifecourse Sciences, Kings College London, London, UK
  • 7 Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
  • 8 Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
  • 9 MRC Clinical Trials Unit, University College London, London, UK
  • 10 Clinical Trials Research Unit, University of Leeds, Leeds, West Yorkshire, UK
  • 11 Sport and Health Sciences, University of Exeter, Exeter, UK
  • 12 Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
  • 13 School of Policy Studies, University of Bristol, Bristol, UK
EClinicalMedicine, 2022 Jun;48:101445.
PMID: 35706495 DOI: 10.1016/j.eclinm.2022.101445

Abstract

BACKGROUND: Exercise is advised for young adults with elevated blood pressure, but no trials have investigated efficacy at this age. We aimed to determine whether aerobic exercise, self-monitoring and motivational coaching lowers blood pressure in this group.

METHODS: The study was a single-centre, open, two-arm, parallel superiority randomized clinical trial with open community-based recruitment of physically-inactive 18-35 year old adults with awake 24 h blood pressure 115/75mmHg-159/99 mmHg and BMI<35 kg/m2. The study took place in the Cardiovascular Clinical Research Facility, John Radcliffe Hospital, Oxford, UK. Participants were randomized (1:1) with minimisation factors sex, age (<24, 24-29, 30-35 years) and gestational age at birth (<32, 32-37, >37 weeks) to the intervention group, who received 16-weeks aerobic exercise training (three aerobic training sessions per week of 60 min per session at 60-80% peak heart rate, physical activity self-monitoring with encouragement to do 10,000 steps per day and motivational coaching to maintain physical activity upon completion of the intervention. The control group were sign-posted to educational materials on hypertension and recommended lifestyle behaviours. Investigators performing statistical analyses were blinded to group allocation. The primary outcome was 24 h awake ambulatory blood pressure (systolic and diastolic) change from baseline to 16-weeks on an intention-to-treat basis. Clinicaltrials.gov registered on March 30, 2016 (NCT02723552).

FINDINGS: Enrolment occurred between 30/06/2016-26/10/2018. Amongst the 203 randomized young adults (n = 102 in the intervention group; n = 101 in the control group), 178 (88%; n = 76 intervention group, n = 84 control group) completed 16-week follow-up and 160 (79%; n = 68 intervention group, n = 69 control group) completed 52-weeks follow-up. There were no group differences in awake systolic (0·0 mmHg [95%CI, -2·9 to 2·8]; P = 0·98) or awake diastolic ambulatory blood pressure (0·6 mmHg [95%CI, -1·4. to 2·6]; P = 0·58). Aerobic training increased peak oxygen uptake (2·8 ml/kg/min [95%CI, 1·6 to 4·0]) and peak wattage (14·2watts [95%CI, 7·6 to 20·9]) at 16-weeks. There were no intervention effects at 52-weeks follow-up.

INTEPRETATION: These results do not support the exclusive use of moderate to high intensity aerobic exercise training for blood pressure control in young adults.

FUNDING: Wellcome Trust, British Heart Foundation, National Institute for Health Research, Oxford Biomedical Research Centre.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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